Differences Between Right-Sided and Left-Sided Colon Cancers

Sadler TW. Langman’s Medical Embryology. 14th ed. Philadelphia: Wolters Kluwer; 2019.

Standring S, editor. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. Elsevier; 2020.

Chaouch MA, Abid N, Gabbouj S, et al. Comparative efficacy and long-term oncological safety of extended right hemicolectomy versus standard right hemicolectomy for splenic flexure cancers: a meta-analysis. Front Oncol. 2024; 13:1244693.

Zenger S, Gürbüz B, et al. Differences Between Right and Left Colon Cancers in Terms of Clinicopathological Features. Turk J Colorectal Dis. 2020;30(4):253–60.

Mik M, Berut M, Dziki L, et al. Right- and left-sided colon cancer – clinical and pathological differences of the disease entity in one organ. Arch Med Sci. 2017;13(1):157–62.

Kalantzis I, Nonni A, et al. Clinicopathological differences and correlations between right and left colon cancer. World J Clin Cases. 2020;8(8):1424–36.

Lee MS, Menter DG, Kopetz S. Right Versus Left Colon Cancer Biology: Integrating the Consensus Molecular Subtypes. J Natl Compr Canc Netw. 2017;15(3):411–9.

Viana EF, et al. Anatomy and pathology of the mesocolon and implications for oncological resection. Front Cell Infect Microbiol. 2020; 10:498502.

Hsu HC, Chen YC, et al. Clinicopathological and molecular differences in colorectal cancer according to location. JGH Open. 2019;3(6):242–250

Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2022 for the treatment of colorectal cancer. Int J Clin Oncol. 2023;28(1):1–43.

Benedix F, et al. Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum. 2010;53(1):57–64.

Lee GH, Malietzis G, Askari A, Bernardo D, Al-Hassi HO, Clark SK. Is right-sided colon cancer different to left-sided colorectal cancer? – a systematic review. Eur J Surg Oncol. 2015;41(3):300–8.

Yahagi M, Okabayashi K, Hasegawa H, Tsuruta M, Kitagawa Y. The Worse Prognosis of Right-Sided Compared with Left-Sided Colon Cancers: A Systematic Review and Meta-analysis. J Gastrointest Surg. 2016;20(3):648–55.

Petrelli F, Tomasello G, Borgonovo K, et al. Prognostic Survival Associated With Left-Sided vs Right-Sided Colon Cancer. JAMA Oncol. 2017;3(2):211–9.

Weiss JM, Pfau PR, O'Connor ES, et al. Mortality by stage for right- versus left-sided colon cancer: analysis of surveillance, epidemiology, and end results–Medicare data. J Clin Oncol. 2011;29(33):4401–9.

Papagiorgis PC, Oikonomou A, Zampetoglou M, et al. Tumor location may affect colorectal cancer morphology and prognosis. Tech Coloproctol. 2010;14(1):51–4.

Ziranu P, Pretta A, Pozzari M, et al. CDX2 expression correlates with clinical outcomes in MSI-H metastatic colorectal cancer patients receiving immune checkpoint inhibitors. Sci Rep. 2023;13:4397. doi:10.1038/s41598-023-31497-2.

Osmond B, Zhang C, Dinh V, Boman BM, Facey COB. HOX Genes and Cancer Stem Cells: Update on HOX expression, DNA methylation, biomarker status, and genetic changes in colorectal cancer. J Stem Cell Res Dev Ther. 2020;6(4):045. doi:10.24966/SRDT-2060/100045.

Lee MS, McGuffey EJ, Morris JS, et al. Association of CpG island methylator phenotype and EREG/AREG methylation and expression in colorectal cancer. Br J Cancer. 2016;114(12):1352–61.

Baran B, Ozupek NM, Tetik NY, et al. Difference Between Left-Sided and Right-Sided Colorectal Cancer: A Focused Review of Literature. Gastroenterol Res. 2018;11(4):264-273.

Toyota M, Ahuja N, Ohe-Toyota M, et al. CpG island methylator phenotype in colorectal cancer. Proc Natl Acad Sci U S A. 1999;96(15):8681–6.

Kane MF, Loda M, Gaida GM, et al. Methylation of the hMLH1 promoter correlates with lack of expression of hMLH1 in sporadic colon tumors. Cancer Res. 1997;57(5):808–11.

Juo YY, Johnston FM, Zhang DY, et al. Prognostic value of CpG island methylator phenotype among colorectal cancer patients: a systematic review and meta-analysis. Ann Oncol. 2014;25(12):2314–27.

Kaz AM, Wong CJ, Dzieciatkowski S, et al. Patterns of DNA methylation in the normal colon vary by anatomical location, gender, and age. Epigenetics. 2014;9(4):492–502.

Guinney J, Dienstmann R, Wang X, et al. The consensus molecular subtypes of colorectal cancer. Nat Med. 2015;21(11):1350–6.

Yamauchi M, Morikawa T, Kuchiba A, et al. Assessment of colorectal cancer molecular features along bowel subsites challenges the conception of distinct dichotomy of proximal versus distal colorectum. Gut. 2012;61(6):847–54.

Liu Y, Sethi NS, Hinoue T, et al. Comparative molecular analysis of gastrointestinal adenocarcinomas. Cancer Cell. 2018;33(4):721–735.e8.

De Roock W, Claes B, Bernasconi D, et al. Effects of KRAS, BRAF, NRAS, and PIK3CA mutations on the efficacy of cetuximab plus chemotherapy in chemotherapy-refractory metastatic colorectal cancer: a retrospective consortium analysis. Lancet Oncol. 2010;11(8):753–62.

Loree JM, Bailey AM, Johnson AM, et al. Molecular landscape of ERBB2/ERBB3-mutated metastatic colorectal cancer. J Natl Cancer Inst. 2018;110(12):1409–17.

Missiaglia E, Jacobs B, D'Ario G, et al. Distal and proximal colon cancers differ in terms of molecular, pathological, and clinical features. Ann Oncol. 2014;25(10):1995–2001.

Sveen A, Bruun J, Eide PW, et al. Colorectal cancer consensus molecular subtypes translated to preclinical models uncover potentially targetable cancer cell dependencies. Clin Cancer Res. 2018;24(4):794–806.

Dienstmann R, Vermeulen L, Guinney J, et al. Consensus molecular subtypes and the evolution of precision medicine in colorectal cancer. Nat Rev Cancer. 2017;17(2):79–92.

Benson AB, Venook AP, Al-Hawary MM, et al. Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19(3):329–59.

Overman MJ, McDermott R, Leach JL, et al. Nivolumab in patients with metastatic DNA mismatch repair-deficient or microsatellite instability-high colorectal cancer (CheckMate 142): an open-label, multicentre, phase 2 study. Lancet Oncol. 2017;18(9):1182–91.

National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Colon Cancer. Version 2.2023.

Yoshino T, Arnold D, Taniguchi H, et al. Panitumumab versus Bevacizumab in RAS Wild-Type Metastatic Colorectal Cancer in the PARADIGM Trial: An Open-Label, Multicenter, Phase III Randomized Controlled Trial. Lancet. 2023;402(10396):1115–29.

Heinemann V, von Weikersthal LF, Decker T, et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol. 2014;15(10):1065–75.

Van Cutsem E, Köhne CH, Láng I, et al. Cetuximab plus irinotecan, fluorouracil, and leucovorin as first-line treatment for metastatic colorectal cancer: updated analysis of overall survival according to tumor KRAS and BRAF mutation status. J Clin Oncol. 2011;29(15):2011–9.

Kopetz S, Grothey A, Yaeger R, et al. Encorafenib, Binimetinib, and Cetuximab in BRAF V600E–Mutated Colorectal Cancer. N Engl J Med. 2019;381(17):1632–43.

Gopalakrishnan V, Helmink BA, Spencer CN, Reuben A, Wargo JA. The influence of the gut microbiome on cancer, immunity, and cancer immunotherapy. Cancer Cell. 2018;33(4):570–80.

Purcell RV, Visnovska M, Biggs PJ, Schmeier S, Frizelle FA. Distinct gut microbiome patterns associate with consensus molecular subtypes of colorectal cancer. Sci Rep. 2017;7(1):11590.

Mima K, Nishihara R, Qian ZR, Cao Y, Sukawa Y, Nowak JA, et al. Fusobacterium nucleatum in colorectal carcinoma tissue and patient prognosis. Gut. 2016;65(12):1973–80.

Wu S, Rhee KJ, Albesiano E, Rabizadeh S, Wu X, Yen HR, et al. A human colonic commensal promotes colon tumorigenesis via activation of T helper type 17 T cell responses. Nat Med. 2009;15(9):1016–22.

Becht E, de Reyniès A, Giraldo NA, Pilati C, Buttard B, Lacroix L, et al. Immune and stromal classification of colorectal cancer is associated with molecular subtypes and relevant for precision immunotherapy. Clin Cancer Res. 2016;22(16):4057–66.

Yanova M, Maltseva D, Tonevitsky A. Sidedness matters: single-cell perspectives on left- and right-sided colorectal cancer. Front Cell Dev Biol. 2025; 13:1720996.

Zhang L, Zhao Y, Dai Y, et al. Immune landscape of colorectal cancer tumor microenvironment from different primary tumor location. Front Immunol. 2018;9:1578

Zhong M, Xiong Y, Ye Z, et al. Microbial community profiling distinguishes left-sided and right-sided colon cancer. Front Cell Infect Microbiol. 2020;10:498502

Lakemeyer L, Wittau M, Henne-Bruns D, Kornmann M, Lemke J. Diagnostic and Prognostic Value of CEA and CA19-9 in Colorectal Cancer. Diseases. 2021;9(1):21.

Lo C-M, Jiang J-K, Lin C-C, et al. Detecting microsatellite instability in colorectal cancer using Transformer-based colonoscopy image classification and retrieval. Diagnostics. 2024;14(5):976.

Hamid MA, Pammer LM, Oberparleiter S, Günther M, Amann A, Gruber RA, et al. Multidimensional differences of right- and left-sided colorectal cancer and their impact on targeted therapies. NPJ Precision Oncology. 2025 Apr 22;9(1):116. doi:10.1038/s41698-025-00892-y.

Vogel JD, Felder SI, Bhama AR, Hawkins AT, Langenfeld SJ, Shaffer VO, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of colon cancer. Dis Colon Rectum. 2022;65(2):148-177. doi:10.1097/DCR.0000000000002323.

Argilés G, Tabernero J, Labianca R, Hochhauser D, Salazar R, Iveson T, et al.; ESMO Guidelines Committee. Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31(10):1291–1305. doi:10.1016/j.annonc.2020.06.022.

Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation—technical notes and outcome. Colorectal Dis. 2009 May;11(4):354-364; discussion 364-365. doi:10.1111/j.1463-1318.2008.01735.x.

Kim MK, Lee IK, Kye B-H, Kim J-G. Procedural difficulty differences according to tumor location do not compromise the clinical outcome of laparoscopic complete mesocolic excision for colon cancer: a retrospective analysis. Oncotarget. 2017;8:64509–64519. doi:10.18632/oncotarget.19780.

Stamos MJ, Brady MT. Anastomotic leak: are we closer to eliminating its occurrence? Ann Laparosc Endosc Surg. 2018;3:66. doi:10.21037/ales.2018.07.07

Green BL, Marshall HC, Collinson F, Quirke P, Guillou PJ, Jayne DG, et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2013 Jan;100(1):75-82. doi:10.1002/bjs.8945.

Moghadamyeghaneh Z, Masoomi H, Mills SD, Carmichael JC, Pigazzi A, Nguyen NT, et al. Outcomes of conversion of laparoscopic colorectal surgery to open surgery: analysis of the National Inpatient Sample (2009–2012). JSLS. 2014;18(4):e2014.00230. doi:10.4293/JSLS.2014.00230.

Nfonsam V, Aziz H, Pandit V, Khalil M, Jandova J, Joseph B. Analyzing clinical outcomes in laparoscopic right vs. left colectomy in colon cancer patients using the NSQIP database. Cancer Treat Commun. 2016;8:1–4. doi:10.1016/j.ctrc.2016.03.006.

Torun M, Uzun O, Duman M, Polat E, Senger AS, Dinçer M, et al. Comparison of oncological outcomes after curative resection for right-side colon cancer and left-side colon cancer: a retrospective observational study. Turk J Colorectal Dis. 2024;34(4):123-129. doi:10.4274/tjcd.galenos.2024.2024-7-3

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Colon Cancer. Version 5.2025. NCCN; 2025.

Grothey A, Sobrero AF, Shields AF, et al. Duration of adjuvant chemotherapy for stage III colon cancer. N Engl J Med. 2018;378(13):1177-1188.

Baxter NN, Morris AM. Adjuvant Therapy for Stage II Colon Cancer. J Clin Oncol. 2022;40(16):1785-1794.

Platt JR, Brown G, Seligmann JF, et al. FOxTROT2: innovative trial design to evaluate the role of neoadjuvant chemotherapy in colon cancer. ESMO Open. 2023;8(1):100276.

Taieb J. FOxTROT: Are We Ready to Dance? J Clin Oncol. 2023;41(3):469-472.

Chalabi M, Fanchi LF, Dijkstra KK, et al. Neoadjuvant immunotherapy leads to pathological responses in mismatch repair-deficient or microsatellite instability-high early-stage colon cancers (NICHE). Nat Med. 2020;26(4):566-576.

ESMO. Metastatic colorectal cancer: ESMO Clinical Practice Guideline.

Le DT, Durham JN, Smith KN, et al. Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science. 2017;357(6349):409-413.

André T, Shiu KK, Kim TW, et al. Pembrolizumab in Microsatellite-Instability-High Advanced Colorectal Cancer. N Engl J Med. 2020;383(23):2207-2218.

Chalabi M, et al. Neoadjuvant Immunotherapy in Locally Advanced dMMR Colon Cancer (NICHE-2). N Engl J Med. 2024.

Vogel JD, Eskicioglu C, Weiser MR, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Colon Cancer. Dis Colon Rectum. 2017;60(10):999-1017.

Lim DR, Kuk JK, Kim T, et al. Oncologic outcomes of right- vs left-sided colon cancer. Medicine (Baltimore). 2017;96(42):e8241.

Jaruhathai S, Santidamrongkul A, Wiwitkeyoonwong J, Duangnapa B. The impact of colon cancer sites on survival rates after curative resection and adjuvant chemotherapy: a single-center study. Asian Pac J Cancer Care. 2022;7(4):615-620. doi:10.31557/apjcc.2022.7.4.615-620.

Asghari-Jafarabadi M, Wilkins S, Plazzer JP, Yap R, McMurrick PJ. Prognostic factors and survival disparities in right-sided versus left-sided colon cancer. Sci Rep. 2024;14:12306. doi:10.1038/s41598-024-63143-3. PMID:38811769.

Sawayama H, Miyamoto Y, Hiyoshi Y, Ogawa K, Kawai K, Baba H, et al. Overall survival after recurrence in stage I–III colorectal cancer patients in accordance with the recurrence organ site and pattern. Ann Gastroenterol Surg. 2021 Jul;5(6):813–822. doi:10.1002/ags3.12483. PMCID: PMC8560596.

Ribic CM, Sargent DJ, Moore MJ, et al. Tumor microsatellite instability status and benefit from fluorouracil-based adjuvant chemotherapy. N Engl J Med. 2003;349(3):247-257.

Masoomi H, Buchberg B, Dang P, Carmichael JC, Mills S, Stamos MJ. Outcomes of right vs. left colectomy for colon cancer. J Gastrointest Surg. 2011 Nov;15(11):2023–2028. doi:10.1007/s11605-011-1655-y. PMID:21845511.

Sargent DJ, Goldberg RM, Jacobson SD, et al. A pooled analysis of adjuvant chemotherapy for colon cancer. J Clin Oncol. 2009;27(12):1948-1956.

Tejpar S, Stintzing S, Ciardiello F, et al. Prognostic and predictive relevance of primary tumor location. JAMA Oncol. 2017;3(2):194-201.

Venook AP, Niedzwiecki D, Innocenti F, et al. Impact of primary tumor location. J Clin Oncol. 2017;35(30):3503-3511.

Overman MJ, Lonardi S, Wong KYM, et al. Nivolumab plus ipilimumab in dMMR/MSI-H CRC. J Clin Oncol. 2018;36(8):773–779.

Bufill JA. Colorectal cancer: evidence for distinct genetic categories based on proximal or distal tumor location. Ann Intern Med. 1990;113(10):779-788.

Wirbel J, Pyl PT, Kartal E, et al. Meta-analysis of fecal metagenomes reveals global microbial signatures of colorectal cancer. Nat Med. 2019;25(4):679-689.

Chen ZK, et al. Gut microbiota and the colorectal cancer tumor microenvironment: recent advances and perspectives. World J Gastroenterol. 2026;32(4):XXX-XXX. doi:10.3748/wjg.v32.i4.XXX. PMCID: PMC12836184.